HIV fear

[pbibc]

Hello Dr.! I am a 31 y.o. male living in Sao Paulo, Brazil. I´ve lost my father to AIDS when I was 13. I have mild depression and OCD, and that´s why I am on fluoxetin (20mg/day). The problem is that on friday I had sex with a female sex worker. She had long fingernails. I have putted the condom in my penis and rejected receiving oral sex (fearing her teeth would rupture the condom), then she putted her fingers on the tip of the condom, rolling them on it (maybe verifying remaining air there). My fear is that while verifying if there was air in the tip of the condom, she has made some kind of hole in it. I have tested the same type of condom at home (the manufacturer is a big multinational corporation) using my fingernails and i´ve noted that I have produced small holes in it, so that when I fill it with water it leaked squirting, without completely breaking the condom even if high pressure were applied making the condom look like a ballon. Questions are:
1.Are there any chances that her fingernails have made small holes on the condom that allowed HIV to contact me? The condom wasn´t broken at the end of the vaginal coitus.
2. I know doctors use to say that if a condom fail, they fail catastrophically, although my experience showed the contrary. What do you say about my experience using my nails, water and pressure without completely breaking or tearing the condoms?
3. Do I need HIV testing?
Thanks for your attention, and I must say that kind of thoughts kills me! Thanks for your beatiful work helping people with their anxieties!

[Edward W Hook, MD]

Brief answers to these very general questions, then the thread needs to end.

When condoms are use correctly and conistently and do not fail, they are the best preventative measure for HIV prevention in sexually active persons.  Thus condom protected sex with CSWs is considered as safe sex.

Men who have sex with other men have more HIV in Western Europe an the Americas for two reasons.  Their sex partners are more likely to have HIV therefore a person is more likely to be having sex with a potentially infectious partner.  In addition, the risk for HIV infectoin is higher with rectal intercourse than with penile vaginal intercourse.  EWH

[pbibc]

Thanks for your answer, Dr.! My mind is at ease now! Do you think it is safe to maintain a sexual life with female sex workers always using condoms? I have heard from some infectologist doctors that they have never seen a case of female to male vaginal HIV transmission, despite the politically correct speech that afirms there are no risk groups anymore. Empirically, aren´t gay males at much higher risk of acquiring HIV (due to receptive anal sex) than heterossexual males who practices vaginal sex?

[Edward W Hook, MD]

You have my condolences regarding the loss of your father.  I can understand how such an event can cause great anxiety for you. Despite that, there is just no reason for activity you describe to have put you at risk for HIV or for other STDs.  The mechanical act of sexual intercourse results in small holes in condoms becoming large, thus, as we have said repeatedly, when condoms fail, they do not unequivocally and without question.  Thus in answer to your questions:

1.  There is no realistic chance that you were infected despite your use of a condom an the fact that it was intact at the completion of your sexual activity.
2.  This is a contrived situation. See my comments above.
3.  No, there is no medical need for testing.  

I hope my comments help.  If you are having trouble putting your concerns aside, I suggest you discuss this further with your mental health care provider.  EWH